The Inflamed Brain In Schizophrenia: The Convergence Of Genetic And Environmental Risk Factors That Lead To Uncontrolled Neuroinflammation
- 1Graduate Program for Neuroscience, Boston University, Boston, MA, United States
- 2Department of Biology, Boston University, Boston, MA, United States
- 3Neurophotonics Center, Boston University, Boston, MA, United States
- 4Center for Systems Neuroscience, Boston University, Boston, MA, United States
- 5Axe Neurosciences, Centre de Recherche du CHU de Québec, Université Laval, Québec City, QC, Canada
- 6Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
- 7Department of Biochemistry and Molecular Biology, The University of British Columbia, Vancouver, BC, Canada
- 8Department of Pharmacology and Experimental Therapeutics, Boston University, Boston, MA, United States
Effects Of Substance Use
Recent studies have reported that cannabis and cigarette smoking are associated with MRI findings of diminished brain tissue volumes in psychotic and nonpsychotic populations. Rates of cannabis use and smoking are much higher in patients who develop schizophrenia and may contribute to the presence of brain volume differences at the time of the FEP. Rais et al found that cannabis-using patients who were followed for 5 years after a FES had greater losses in gray matter volumes and increases in lateral ventricle volumes than patients who were not abusing cannabis. Alcohol is also known to lead to reduction in brain tissue volumes and to compound the differences observed in patients with schizophrenia. That cannabis, alcohol, and smoking may all contribute to the magnitude of gray matter deficits observed in patients with schizophrenia is supported by recent findings by Stone et al who found that at low to moderate levels, all were associated with lower gray matter volumes in individuals at high risk of psychosis and in healthy controls.
Stress And The Hypothalamic
The elevated glucocorticoid levels associated with chronic stress that patients with schizophrenia manifest may also contribute to the smaller brain tissue volumes observed. Effects of stress and glucocorticoids on hippocampal and ventricular volumes have been demonstrated in animal models and in humans with Cushings syndrome, and these are known to be at least partially reversible., In patients with a FEP, cortisol levels have been found to be raised and to correlate inversely with hippocampal volumes.
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What Can I Expect From Schizophrenia
If you have schizophrenia, you should know that the course of this brain disease varies greatly. Medication can often control your symptoms. If you take your medication exactly as directed, you will likely have a mild type of the disease. In that case, you will have only one or two relapses in total by the age of 45 and will show only minor symptoms. If you have moderate schizophrenia, you will likely have several major relapses by the age of 45, plus symptoms during stressful times, and you will have persistent symptoms between relapses. This often results from taking your medication most, but not all, of the time. Not taking medication at all or dropping out of treatment often causes a severe and unstable course of the disease. If you have this type, you will only be stable for a short period of time between relapses. You may have serious symptoms and need help with your day-to-day life.
Facts You Should Know About Schizophrenia
- Schizophrenia is a chronic, severe, debilitating mental illness that affects about 1% of the population — more than 2 million people in the United States alone.
- With the sudden onset of severe psychotic symptoms, the individual is said to be experiencing acute psychosis. Psychotic means out of touch with reality or unable to separate real from unreal experiences.
- There is no known single cause of schizophrenia. As discussed later, it appears that genetic and other biological factors produce a vulnerability to schizophrenia, with environmental factors contributing to different degrees in different individuals.
- There are a number of various schizophrenia treatments. Given the complexity of this disorder, the major questions about the illness are unlikely to be resolved in the near future. The public should beware of those offering “the cure” for schizophrenia.
- Schizophrenia is one of the psychotic, also called thought-disordered, mental disorders and affects a person’s thoughts, behaviors, and social functioning.
- disorganized speech or behavior.
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Exposure To Pollution Causes Neuroinflammation
The environment is becoming increasingly polluted from multiple sources. Traffic-related air pollution , such as diesel exhaust , is the result of the combustion of fossil fuels and can be modeled in the lab using elemental carbon or by taking the finest particles from TRAP and re-aerosolizing them into nanoparticulate matter . nPM is the most toxic component of TRAP, in terms of its impact on the brain . By-products of TRAP, such as ozone , which can be generated from nitrogen oxide, can also be changed photochemically after their release from motor vehicles . Altogether, multiple paradigms are currently used in animal models to study the effects of air pollution on brain development . This work is particularly relevant when considering the epidemiological studies that link air pollution to SCZ pathogenesis . Indeed, many of the genes altered in SCZ overlap with genes that are affected by exposure to air pollution . Interestingly, immune genes, including those expressed by microglia, are at the center of this interaction .
Table 1. Overview of the effects of different pollutants on neuroinflammation.
How Will A Family Member With Schizophrenia Act
You may notice schizophrenia developing between adolescence and the age of 40, which is the most common time that it first appears. However, children and older adults can also develop schizophrenia. If your loved one had been ill for a long period of time, this can be a precursor to schizophrenia. You may notice the first episode if the patient seeks help when delusions or hallucinations trigger unusual behavior. Patients who seek help have a good chance of recovering from the episode within a few months.
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What Professionals Diagnose And Treat Schizophrenia Are There Particular Tests That Assess Schizophrenia
As is true with virtually any mental health diagnosis, there is no one test that definitively indicates that someone has schizophrenia. Therefore, health care professionals like psychiatrists or other psychiatric medication prescribers, clinical psychologists or primary care providers diagnose this illness by gathering comprehensive medical, family, and mental health information. Patients tend to benefit when the practitioner performs a systematic review of their client’s entire life and background. Examples of this include the person’s gender, sexual orientation, cultural, religious and ethnic background, socioeconomic status, family, and other social relationships. The symptom sufferer might be asked to fill out a self-test that the professional will review if the person being evaluated is able to complete it.
The practitioner will also either perform a physical examination or request that the individual’s primary care doctor perform one. The medical assessment will usually include lab tests to evaluate the person’s general health and to explore whether or not the individual has a medical condition or has been exposed to certain medications that might produce psychological symptoms.
Is It Possible To Prevent Schizophrenia
Prevention of schizophrenia for individuals who have yet to develop even the early symptoms of the disorder focuses on decreasing many of the environmental insults that increase the likelihood of developing the disorder. Therefore, improving prenatal care, ameliorating poverty, bullying, child abuse and neglect, as well as protecting people from family and community violence are important aspects of preventing schizophrenia. For people who show early signs of schizophrenia, some clinical trial research is exploring the potential use of medications to prevent full-blown schizophrenia.
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What Are The Types Of Schizophrenia
There are different types of schizophrenia. The International Classification of Diseases manual describes them as below.
- Pranks, giggling and health complaints.
- Usually diagnosed in adolescents or young adults.
- Unusual movements, often switching between being very active and very still.
- You may not talk at all.
- Negative symptoms are prominent early and get worse quickly.
- Positive symptoms are rare.
Your diagnosis may have some signs of paranoid, hebephrenic or catatonic schizophrenia, but doesnt obviously fit into one of these types alone.
This type of schizophrenia is diagnosed in the later stages of schizophrenia. You may be diagnosed with this if you have a history of schizophrenia but only continue to experience negative symptoms.
There are other types of schizophrenia according to the ICD-10, such as.
- Cenesthopathic schizophrenia. This is where people experience unusual bodily sensations.
- Schizophreniform. Schizophreniform disorder is a type of psychotic illness with symptoms similar to those of schizophrenia. But symptoms last for a short period.
Symptoms meet the general conditions for a diagnosis, but do not fit in to any of the above categories.
The Time Course Of Cognitive Deficits
When cognitive deficits are first present and whether there is some stage of the illness during which they progress have been areas of intensive study., Cognitive deficits have been clearly demonstrated at the time of the FEP.,, Cognition has been demonstrated to remain stable or improve, rather than deteriorate following a FEP. The improvement reported in some studies may reflect practice effects rather than real improvement. Nevertheless, there is a consensus that this improvement plateaus following a FEP or FES, after which cognition does not worsen over time beyond what can be expected with normal aging.,, Whether elderly patients with schizophrenia may experience a phase of cognitive decline that is of greater slope than that observed in otherwise healthy people, remains a possibility that requires further investigation.
In accord with the above, individuals considered to be at clinical high risk for psychosis have been demonstrated to have significant cognitive deficits with those who eventually develop psychosis having greater deficits than those who do not. However, studies by Keefe et al and Becker et al were not able to demonstrate any further deterioration in cognition in those at-risk subjects who subsequently transitioned to psychosis. The potential for such studies to identify significant deterioration in cognition has been limited by their small sample sizes and their identification of at-risk subjects late in the prodromal phase.
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Can Schizophrenia Be Treated
Yes. The main types of treatment are counseling and medicines to lessen or stop psychotic symptoms. Medicines will control psychotic symptoms in most people. In milder cases of schizophrenia, medications may not be needed. Medicines can:
- Lessen or stop hallucinations
- Help the person tell the difference between hallucinations and the real world
- Lessen or stop false beliefs
- Lessen feelings of confusion
- Help the person think more clearly
Lessening of these symptoms can help the person resume his or her normal lifestyle and activities. Medicines for schizophrenia need to be taken regularly, even after symptoms are gone. Some people with schizophrenia will stop taking their medicine because they believe the medicine is no longer needed, or they dislike the medication’s side effects. Psychotic symptoms often return when medication is stopped. Do not stop taking medicine without the advice of your healthcare provider.
Discuss any concerns you have about side effects with your healthcare provider.
The Search For Progressive Brain Changes
Researchers have sought to identify structural brain changes in schizophrenia since the time of Kraepelin. Postmortem and pneumoencephalographic studies, provided support for the presence of atrophic brain changes in some patients with chronic schizophrenia. However, the opportunity to systematically investigate brain structure emerged in the 1970s and 1980s. Computed tomography revealed that patients with schizophrenia on average had larger intracranial cerebrospinal fluid volumes, including larger lateral ventricles, and cortical sulci., Subsequent MRI studies demonstrated widespread deficits in gray matter volumes, and white matter volumes. The magnitude of these group differences was observed to be greater for more chronically ill patients. From the outset, both CT and MRI studies sought to demonstrate associations between illness duration and the magnitude of CSF and gray matter volumes, but with little success.,
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What Are The Symptoms Of Schizophrenia And How Is It Diagnosed
How is schizophrenia diagnosed?
Only a psychiatrist can diagnose you with schizophrenia after a full psychiatric assessment. You may have to see the psychiatrist a few times before they diagnose you. This is because they need to see how often you are experiencing symptoms.
There are currently no blood tests or scans that can prove if you have schizophrenia. So, psychiatrists use manuals to diagnose schizophrenia and other mental illnesses.
The 2 main manuals used by medical professionals are the:
- International Classification of Diseases which is produced by the World Health Organisation , or
- Diagnostic and Statistical Manual which is produced by the American Psychiatric Association .
NHS doctors use the ICD-10.
The manuals explain which symptoms should be present, and for how long for you to receive a diagnosis. For example, according to the NHS you need to be hearing voices for at least 1 month before you can be diagnosed. Mental health professionals may say you have psychosis before they diagnose you with schizophrenia.
What is the future of diagnosis in schizophrenia?There are many research studies being conducted across the world on how to better diagnose schizophrenia. For example, a recent study found through looking at images of the brain, there may be different sub-types of schizophrenia.
What are the symptoms of schizophrenia?
The symptoms of schizophrenia are commonly described as positive symptoms or negative symptoms. This doesnt mean that they are good or bad.
Frequently Asked Questions About Schizophrenia
Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality. Although schizophrenia is not as common as other mental disorders, the symptoms can be very disabling.
Schizophrenia is a severe and debilitating brain and behavior disorder affecting how one thinks, feels and acts. People with schizophrenia can have trouble distinguishing reality from fantasy, expressing and managing normal emotions and making decisions. Thought processes may also be disorganized and the motivation to engage in lifes activities may be blunted. Those with the condition may hear imaginary voices and believe others are reading their minds, controlling their thoughts or plotting to harm them.
While schizophrenia is a chronic disorder, it can be treated with medication, psychological and social treatments, substantially improving the lives of people with the condition.
A moving presentation by Dr. Kafui Dzirasa on Schizophrenia
View Webinar on Identifying Risk Factors and Protective Pathways for Schizophrenia
Schizophrenia affects men and women equally. It occurs at similar rates in all ethnic groups around the world. Symptoms such as hallucinations and delusions usually start between ages 16 and 30.
Learn more about childhood-onset schizophrenia from this expert researcher:
Find answers to more questions about Schizophrenia in our Ask the Expert section.
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Conditions That Can Seem Like Schizophrenia
- Psychotic symptoms including hallucinations, hearing voices, or believing someone or something is out to get you
- Negative symptoms such as a lack of interest or an inability to take pleasure in daily activities and spending time with others
- Cognitive symptoms including trouble focusing and making decisions
Many of the symptoms of schizophrenia are also symptoms of other conditions. Because of this, people often get misdiagnosed.
Other disorders and conditions that are sometimes mistaken for schizophrenia include:
Schizoaffective disorder. Schizoaffective disorder causes many of the symptoms of schizophrenia, like delusions. But people with schizoaffective disorder also have periods of depression or periods where they feel extremely energized or happy . Thatâs not usually the case with schizophrenia.
Schizoid personality disorder. A person with schizoid personality disorder avoids social situations and interacting with others. They usually have a hard time feeling and expressing emotions. Even though schizoid personality disorder sounds a lot like schizophrenia, people who have schizoid personality disorder donât have delusions or hallucinations.
Disease Classifications Should Drop This Unhelpful Description Of Symptoms
- The term ‘schizophrenia,’ with its connotation of hopeless chronic brain disease, should be dropped and replaced with something like ‘psychosis spectrum syndrome,’ argues a professor of psychiatry.
The term “schizophrenia,” with its connotation of hopeless chronic brain disease, should be dropped and replaced with something like “psychosis spectrum syndrome,” argues a professor of psychiatry in The BMJ today.
Professor Jim van Os at Maastricht University Medical Centre says several others have called for updated psychiatric classifications, particularly regarding the term “schizophrenia.” Japan and South Korea have already abandoned this term.
The official list of mental disorders that doctors use to diagnose patients is found in ICD-10 and DSM-5 .
But Professor van Os argues that the classification is complicated, particularly for psychotic illness.
Currently, psychotic illness is classified among many categories, including schizophrenia, schizoaffective disorder, delusional disorder, depression or bipolar disorder with psychotic features, and others, he explains.
But categories such as these “do not represent diagnoses of discrete diseases, because these remain unknown rather, they describe how symptoms can cluster, to allow grouping of patients.”
“That is how our classification system works. We don’t know enough to diagnose real diseases, so we use a system of symptom based classification.”
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Impact Of The Immune System On Synapse Development In Scz
It is well-established that spine dysfunction is present in SCZ and is at least partially mediated by reductions in excitatory synaptic connectivity and plasticity . However, most of the work in this field has relied on human post-mortem tissue, so there is limited knowledge of what could be occurring earlier in development to drive these synaptic alterations. Recent work has highlighted the fact that the immune system works closely with the CNS to establish and refine neural circuits in healthy states as a part of normal development . However, when this process is dysregulated, it can lead to pathology and the miswiring of the brain through synaptic loss , which occurs in SCZ.